Provider Demographics
NPI:1659681591
Name:GILLISH, GRANT KURTIS (DDS)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:KURTIS
Last Name:GILLISH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W COLBY ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1083
Mailing Address - Country:US
Mailing Address - Phone:231-893-2915
Mailing Address - Fax:231-893-4719
Practice Address - Street 1:116 W COLBY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1083
Practice Address - Country:US
Practice Address - Phone:231-893-2915
Practice Address - Fax:231-893-4719
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010203101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice